Wanted to have some dental work done & on speaking to a specialist dental surgery, when they heard I was taking Alendronic Acid & Prednisolone they just didn't want to touch me.
Have been to visit my regular dentist today who said anything like an extraction or implant he wouldn't do & I would have to have it done in a hospital setting.
x2 rheumies have put me on this drug & neither have mentioned ANYTHING at all about this.
The dentist today said even if I stopped taking the drugs he wouldn't want to do any major dental treatment, too risky of getting an infection that couldn't be controlled.
Anybody else come across this problem & what they did they do about it?
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Purpleprimate
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My sister had to stop Risedronate ( biphosphonate, same thing I think) for 4 months before having a wisdom tooth extracted. I believe the danger is a small chance of jaw bone necrosis. If the dental treatment is urgent, they might do it after you stop the medication for a few months.
yes but in a different way, my dentist always insists I take antibiotics before any treatment even scale and polish due to my rheumatoid condition even though I’ve been med. free since mid 20s and nearly 61 now!
I have a couple of extractions coming up (🤞) and my dentist has asked me to discuss with GP increasing pred for a day or two. No mention at all of the denosumab injections that I have for osteoporosis…..There are guidelines for dentists about these things but they seem o interpret them differently!
Is denosumab a Biophosphate? If not it might be OK. From what my dentist said it was pretty universal that dentists would be exceedingly careful with patients that took Biophophates with steroids.
He knows all the meds I’m on and is happy to continue, as long as I “have a consultation “ with my GP first. He’s an excellent dentist, used to work in the hospital dental department, and if I understand correctly, still does shifts there. He’ll know what could go wrong and as he says, I need the teeth out or I’m at risk of infection and pain from dental caries….so he’s willing to do the work, bless him xx
my doctor told me to get any dental work done before taking alendronic acid. It is not the pred but the acid they are concerned about. I researched and didn’t take it. I had a bone density scan and did not require it. I do take d3/calcium tablets plus k2
It is common to meet dentists who are so risk averse they won't touch a patient who has been on long term bisphosphonates. You should have been told to get any invasive work that might be required done before starting the drug and I would certainly complain about not having been warned at that stage.
It does seem to depend on the dentist and to be honest I don't quite understand the "it will have to be done in hospital" attitude since it isn't the actual process that is the problem but healing of the bony socket afterwards
Thank you PMRpro, but now having been told about this (....& you really don't want to get this etc ect) I'm now feeling quite scared about having an implant. I will speak with some other dentists & get more feedback.
While I'm here, just another question. I'm fed up with telling people what PMR is. Is there a full comprehensive description of possible cause, ALL symptoms & treatment somewhere on this site? I can then print it off & give it to people to read at their leisure. It's when they say 'but you look well' that's quite irritating. Thanks.
There wouldn't be room - it would need a book! I can't remember what's in the FAQs but there is a video on YouTube and the forum that explains what it does to us
But over and above the fact that the immune system eventually turns on the body after a lifetime of factors poking at it and upsetting its balance, I don't think anyone knows all possible causes of PMR, never mind us on the forum.
My dentist referred me to the hospital for an extraction saying he wanted me to have "the least traumatic extraction possible"! I mentioned this to the hospital dental nurse and she said that my dentist might do an extraction only once every couple of weeks, but that are doing them "all day and every day". The hospital dentist took 10 - 15 minutes to slowly loosen the tooth and 3 months later, I've just seen my own dentist who says it's healed well. I had been on Risedronate for 5 years and stopped as soon as I knew I needed the extraction. I waited 51 weeks for the hospital procedure, so that gave me time off the medication, although I realise it is still in my bones!
Dental work: yes it would be nice if the reumatoloog checked, before prescribing a bisphosfonate.
After taking it for 2 years, as was to be expected with my teeth, trouble.
My dentist refused to remove a badly infected element, well …. after I told him what was lurking behind the farmaceutical name on my list, and refered me to a specialist surgeon.
Extrection went fine, four weeks later there was a sharp and growing ridge of jaw bone, threatening to break the skin. Specialist advised to brush with great care to ward of infection. But there was nothing he could do about it. . I stopped the bisfosfonate pills instantly.
Six months later: I manager to keep the skin stretchend over the growing bone intact and the ridge is now receding. I am lucky.
So, yes it is a risk, and no, a specialist can’t do a lot when your jawbone starts to grow. With alarming speed, I must add.
I think it is an insurance matter, the refering to a specialist.
In the Netherlands dentists are private practices and a specialist in a hospital is covered by the overall hospital insurance. So if anyone wants to start a liability case?
In a perfect world, yes, rheumies would ask.
And a high dosis of prednison does make it more difficult to heal , once you get an abrasion.
I do hope, Purpleprimate, your dental work is not very urgent, it can get so painfull. All the best!
Omakaat, thanks for that. That sounds pretty horrific & don't want any of that to happen to me. I started Alendronic Acid on the advice of one rheumy & who then said I could come of it after 5 months as my DEXA scan was normal. A new rheumy said it was very important to take it anyway so started again but have only been taking it for a few weeks so given the new info will now stop for good.
yes, referred to surgeon, who would not remove for fear of me getting jaw necrosis. Back to dentist who would not remove it. I had 8 infections in sane tooth in two years! Did you look at FAQs, or search on dental treatment…you will find so much info there! Finally I was given options, my dentist would try a root canal filling, but was sure it wouldn’t work (& I may end up in hospital), or pay £800 for a specialist root canal filling, ir nothing. I opted for no action, & just hope I don’t get another infection. I stopped the biophosphonate straight away, & I’m hoping to have done 2 or 3 years before I need the tooth removed! Good luck, S xx
here’s my post, there were many helpful comments & advice if you want to look it up, it could help you…History: 4 tooth infections (same tooth) in 4 years. 5 courses of antibiotics. More toothache & swelling. Off to dentists (closed for 2 years due to Covid). X-Ray & exam…tooth needs to come out, & explains why root canal wouldn’t work. Good, yes please, I said. But due to fact I’m on low dose of pred, & I’ve had some adrenal insufficiency symptoms, she won’t remove it & said I will have to have it done at the hospital, she asks another colleague, as I just want shot of it, & he says no. Consultant surgeon phones three weeks later. She says that due to two years of taking Alendronic Acid, I am at medium to high risk of MRONJ, or necrosis of the jaw. She explains how awful that is. (I googled it, no way do I want it!) She says she will add me to 3 month waiting list for extraction while I choose what to do. She thinks it’s best to have the tooth ‘capped off’ & says it won’t be a useful, chewing tooth, but smooth on top, & no risk of adrenal insufficiency or necrosis of the jaw. I posted so others can see how taking pred & alendronic avid can affect something I felt was unrelated to PMR at all, but seemed very simple to me, just one tooth removal! Would love to hear if anybody has had ONJ, also known as MRONJ (M ronge, as she pronounced it!) or if people have had teeth extracted with no issues (also learned that it can take months for ‘wound site’ to heal)! DL has provided a good link for me to read about alendronic acid, but I’d love to hear any personal advice or experience, as I have to make my mind up whether to have it removed, or capped off (I’ve never heard of this flat topped capped off tooth, either!!) Thanks in advance!
I was just about to send you a message about my experience! See my reply to PMRpro, above. I've waited until this week, as I saw my dentist on Monday, 3 months after having had the extraction at the hospital in December. I wasn't offered the capping off, but that does sound like a good compromise which wouldn't affect the jaw bone. All the best for whatever you decide. 🌷
Thanks Rugger, I think the dentists are being extremely careful as they are worried of being sued if it all goes wrong. The first 'dental practice' I spoke to said they would never give any treatment to someone who had been on Alendronic Acid even if they'd been off it for years.
Wonderful - I trust they still do non-invasive dental treatments? There is no reason not to do that. But they should also make such feeling more widely known since it leaves patients in a pretty poor situation for no fault of their own.
great to hear from you, & that you’ve had the extraction…& healed! That’s a relief! I decided to do nothing…the thought of a crumbling tooth & a dentist picking out bits, or then unable to cap it…no thanks! I’ve been off over a year now, & I haven’t had another infection…some gum swelling, but nothing like the previous infections! I’m expecting to be off steroids in 3 months (consultant’s instructions) , so, in six/nine months I may be able to have a normal extraction!! Yippee! Taje care, S xx
'Both BPs and Dmab are generally considered safe, although they have been correlated to rare adverse events, such as osteonecrosis of the jaw and atypical femoral fractures.'
I took AA for a while, then switched to Dmab for the sake of my stomach. My dentist said it wouldn't affect any treatment, but they would just be extra careful if doing an extraction, etc. Maybe it's just down to the confidence of the dentist?
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